Should everybody use a statin to prevent heart disease and stroke?

I have heard that older men and women should take statins to prevent heart disease, even if their cholesterol is normal. Please advice, thanks.

Doctors often prescribe statins for patients with high cholesterol to  reduce their risk of a heart attack or stroke. Most people taking statins will take them for the rest of their lives, which can make statin side effects difficult to manage.

In a patient with normal cholesterol levels and no risk factors such as diabetes, high blood pressure or cardiovascular disease, it is hard to justify the potential side effects and costs.

Therefore, the routine use of a statin in patients with normal cholesterol levels is somewhat controversial 1). Current guidelines for the prevention of heart disease and stroke are limited to patients who have a 20% or greater 10-year risk of developing CVD 2), Preventive measures for heart disease rather focus on behavior modification such as diet , exercise and cessation of smoking. (You can calculate your risk here).

The preventive use of statins should also include clinical assessment of older patients with diabetes or high-risk ethnic groups. The decision to begin statin therapy should be made after a discussion with your doctor about the risks and benefits of statin treatment, taking your overall health into account.

Potential benefits:

Statins may have benefits other than just lowering your cholesterol. One promising benefit of statins appears to be their anti-inflammatory properties, which help stabilize the lining of blood vessels. This has potentially far-reaching effects, from the brain and heart, to blood vessels and organs throughout the body. In the heart, stabilizing the blood vessel linings would make plaques less likely to rupture, thereby reducing the chance of a heart attack.

Potential side effects of cholesterol therapy with statins:

Not everyone who takes a statin will have side effects, but some people may be at a greater risk than are others. Risk factors include:

  • Taking multiple medications to lower your cholesterol
  • Being female
  • Having a smaller body frame
  • Being age 65 or older
  • Having kidney or liver disease
  • Having type 1 or 2 diabetes

Although statins are well tolerated by most people, they do have side effects, some of which may go away as your body adjusts to the medication.

Common, less serious side effects

  • Muscle and joint aches (most common)
  • Nausea
  • Diarrhea
  • Constipation

Potentially serious side effects

Liver damage. Occasionally, statin use causes an increase in liver enzymes. If the increase is only mild, you can continue to take the drug. If the increase is severe, you may need to stop taking it, which usually reverses the problem. Because liver problems may develop without symptoms, people who take statins have a blood test six weeks after starting a statin medication to check their liver function.

Muscle problems. Statins may cause muscle pain and tenderness (statin myopathy). The higher the dose of statin you take, the more likely you are to have muscle pains. In severe cases, muscle cells can break down (rhabdomyolysis) and release a protein called myoglobin into the bloodstream. Myoglobin can damage your kidneys.

Digestive problems
Some people taking a statin may develop nausea, gas, diarrhea or constipation after taking a statin. These side effects are rare. Most people who have these side effects already have other problems with their digestive system. Taking your statin medication in the evening with a meal can reduce digestive side effects.

Rash or flushing
You could develop a rash or flushing after you start taking a statin. If you take a statin and niacin, either in a combination pill such as Simcor or as two separate medications, you're more likely to have this side effect. Taking aspirin before taking your statin medication may help, but talk to your doctor first.

Hope this helps,

Dr T


1): Statin usage in low-risk patients

2): Lipid modification, Cardiovascular risk assessment and the modification of blood lipids for the primary and secondary prevention of cardiovascular disease, NHS, NICE guidelines, last updated March 29,2011

3): Statin side effects: Weigh the benefits and risks, Mayo Clinic


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